Trabeculectomy in an unsuspected extramedullary iris–ciliary body plasmacytoma

2020 ◽  
pp. 112067212092022
Author(s):  
Harathy Selvan ◽  
Seema Kashyap ◽  
Seema Sen ◽  
Bhavna Chawla ◽  
Neiwete Lomi ◽  
...  
Keyword(s):  
Ciliary Body ◽  
Histopathological Examination ◽  
Neovascular Glaucoma ◽  
Ultrasound Biomicroscopy ◽  
Extramedullary Plasmacytoma ◽  
Plasma Cell Dyscrasia ◽  
Post Operative Period ◽  
Bleb Failure ◽  
Disease Free

Extramedullary plasmacytoma of the iris and ciliary body is extremely rare. We present a case which was misdiagnosed as granulomatous uveitis with neovascular glaucoma, and underwent a trabeculectomy with mitomycin-c along with iris biopsy. The post-operative period showed early bleb failure and catastrophic growth of the suspected mass. Histopathological examination revealed a diagnosis iris plasmacytoma. Subsequent ultrasound biomicroscopy showed involvement of the iris and ciliary body. A prompt systemic workup was done, and an associated systemic plasma cell dyscrasia was ruled out. The affected eye was enucleated, and the patient remains disease free at the end of 3-year follow-up.

scholarly journals Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haibo Li ◽  
Jinhong Cai ◽  
Xiaofeng Li
Keyword(s):  
Ciliary Body ◽  
Ocular Trauma ◽  
Ultrasound Biomicroscopy ◽  
Bulbar Conjunctiva ◽  
Mattress Suture ◽  
The Difference ◽  
Ab Interno ◽  
Cyclodialysis Cleft

Abstract Background To investigate the efficacy and safety of continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30-gauge (G) needle. Methods Fifteen patients (15 eyes) with traumatic cyclodialysis cleft admitted to the ocular trauma department of our hospital from July 2014 to December 2018 were included in this study. After the bulbar conjunctiva corresponding to the ciliary body was incised along the corneal limbus, an incision was made along the corneal limbus on the opposite side. A 30G needle with a 10–0 suture entered the anterior chamber from the incision and passed through the ciliary body with clefts and the sclera to fixate the ciliary body on the sclera wall with continuous mattress suture. The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were observed preoperatively and postoperatively. In vivo ultrasound biomicroscopy (UBM) was performed to observe closure of cyclodialysis cleft before and after surgery. Results Fifteen patients successfully underwent continuous mattress suture for repair of cyclodialysis cleft. No bleeding and suture breakage were reported during surgery. After surgery, the UBM during follow-up showed satisfactory closure of the cyclodialysis cleft. The BCVA and IOP were improved to different degrees. The difference between the preoperative IOP and the postoperative IOP (1 week) was statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 16.17 ± 4.65 mmHg, t = − 8.43, P < 0.05), and the difference between the preoperative IOP and the postoperative IOP (1 month) was also statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 14.63 ± 3.63 mmHg, t = − 8.38, P < 0.05). Duration of outpatient follow-up was 3 to 12 months. No complications, including exposed knots, loose sutures, decompensation of corneal endothelium, sympathetic ophthalmia, endophthalmitis and choroidal detachment, were reported. Conclusion Continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30G needle is a safe and effective procedure with simple operation, little tissue damage and few complications.

Long-term Follow-up of 42 Patients with Small Ciliary Body Tumors with Ultrasound Biomicroscopy

2010 ◽  
Vol 149 (4) ◽  
pp. 616-622 ◽  
Author(s):  
Daniel J. Weisbrod ◽  
Charles J. Pavlin ◽  
Wei Xu ◽  
E. Rand Simpson
Keyword(s):  
Ciliary Body ◽  
Ultrasound Biomicroscopy ◽  
Long Term Follow Up

scholarly journals A Case Report of Chondrosarcoma of Temporomandibular Joint

2021 ◽  
Author(s):  
Hage Ampu ◽  
Tanya Singh ◽  
Sunil Kumar ◽  
H. P. Singh ◽  
Shalini Bhalla
Keyword(s):  
Case Report ◽  
Temporomandibular Joint ◽  
Histopathological Examination ◽  
Mandibular Condyle ◽  
Joint Space ◽  
Neuralgic Pain ◽  
Well Differentiated ◽  
The Right ◽  
Disease Free

AbstractIn this case report we describe a rare case of chondrosarcoma of the Temporomandibular joint in a 70 years old female who presented with a right preauricular swelling, trismus and neuralgic pain. On examination, firm and tender swelling was noted in the right preauricular region. CT Scan revealed 3.48 × 3.0 cm size mass lesion in the region of mandibular condyle and extending into the right temporomandibular joint space. The cytopathological report was suggestive of chondroid malignancy. The tumor was excised and histopathological examination showed large sheets of atypical tumor cells with cartilaginous matrix and diagnosis of a well differentiated Chondrosarcoma was confirmed. Post-surgical resection, patient remains disease free at 15 months follow up.

scholarly journals Malignant Mesothelioma of the Epididymis: A Case Report of a Rare Paratesticular Neoplasm and Literature Review

2020 ◽  
pp. 1-3
Author(s):  
Jasser Maatougui ◽  
Jasser Maatougui ◽  
Mehdi Raboudi ◽  
Tarek Taktak ◽  
Issam Msakni ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Malignant Mesothelioma ◽  
Poor Prognosis ◽  
Histopathological Examination ◽  
Multidisciplinary Management ◽  
Case Presentation ◽  
Scrotal Ultrasound ◽  
Disease Free

Background: Malignant mesothelioma of the epididymis is an extremely rare neoplasm with a poor prognosis and high potential of recurrence. Case Presentation: We report a case of a 28-year-old male with a left painless epididymal nodule. Scrotal ultrasound revealed a nodular mass with mixed echogenicity and Doppler showed increased vascularity. Radical orchidectomy was performed. Histopathological examination concluded to a malignant mesothelioma involving the epididymis. Metastatic workup was negative. The patient has undergone a regular follow-up and has been disease-free within 6 months. Conclusion: Malignant mesothelium of the epididymis is a diagnosis challenge. Surgery remains the main treatment. A multidisciplinary management should be offered in those cases.

Proton beam irradiation of uveal melanoma involving the iris, ciliary body and anterior choroid without surgical localisation (light field)

2020 ◽  
pp. bjophthalmol-2020-318063
Author(s):  
Monica M Oxenreiter ◽  
Anne M Lane ◽  
Mary Beth Aronow ◽  
Helen Shih ◽  
Alexei V Trofimov ◽  
...  
Keyword(s):  
Proton Beam ◽  
Uveal Melanoma ◽  
Ciliary Body ◽  
Light Field ◽  
Retrospective Chart Review ◽  
Neovascular Glaucoma ◽  
Beam Irradiation ◽  
Proton Beam Irradiation ◽  
Set Up

AimsTo assess treatment outcomes after proton beam irradiation (PBI) without surgical localisation of uveal melanomas involving the iris, ciliary body and anterior choroid.MethodsRetrospective chart review of 125 patients evaluated at Massachusetts Eye and Ear and treated with PBI using a light field set-up without localisation surgery between November 1975 and April 2017. The tumours were characterised as follows: iris (n=18, 14.4%), ciliary body (n=12, 9.6%), iridociliary (n=58, 46.4%), ciliochoroidal (n=24, 19.2%) and iridociliochoroidal (n=13, 10.4%). The tumours were measured by transillumination and ultrasonography before treatment. Tumours with posterior margin located less than two disc diameters from the ora serrata were treated using the light field technique. Patient outcomes after PBI were evaluated.ResultsMost patients had good vision at the time of tumour diagnosis (69.6% had baseline visual acuity (VA) of ≥20/40). Median VA at last follow-up (median follow-up: 72.1 months) was 20/63. Recurrences occurred in 12 patients (9.6%) at a median time of 4.0 years post-treatment. Recurrences were treated by repeat PBI (n=5) or enucleation (n=7). Secondary enucleation was performed in 18 patients (14.4%), and 61.1% of these were due to complications. Neovascular glaucoma (NVG) developed in 21 patients (16.8%). Of seven patients who developed NVG after anti-vascular endothelial growth factor (anti-VEGF) therapies became available, five were treated with intravitreal Avastin injections (23.8% of patients with NVG). Of 69 patients diagnosed with cataract after treatment, 51 (73.9%) were characterised as radiation-related. Death from metastatic uveal melanoma occurred in 20.8% of the cohort, with a median follow-up of 10.1 years.ConclusionsPatients treated with PBI using a light field set-up technique experience good outcomes after irradiation. Eye preservation and retention of good VA are seen in the majority of cases, and tumour recurrence is low.

scholarly journals A Comparative Study between Ultrasound Cycloplasty and Cyclocryotherapy for the Treatment of Neovascular Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Wang Ruixue ◽  
Wang Tao ◽  
Li Ning
Keyword(s):  
Pain Relief ◽  
Ciliary Body ◽  
Primary Outcome ◽  
Histological Study ◽  
Neovascular Glaucoma ◽  
Secondary Outcome ◽  
Matrix Metalloproteinase 1 ◽  
The Mean ◽  
Histological Effect

Purpose. To compare the clinical efficacy, safety, and histological effect between ultrasound cycloplasty (UCP) and cyclocryotherapy in the treatment of neovascular glaucoma. Methods. Two groups of neovascular glaucoma patients who underwent two types of treatment, respectively, namely, 26 patients treated by UCP and 23 by cyclocryotherapy, were treated and observed during the clinical study for six months. The primary outcome was evaluated by the surgical success, which was defined as the intraocular pressure (IOP) reduction of greater than or equal to 20% from the baseline and the IOP value of greater than 5 mmHg at the last follow-up. The secondary outcome referred to pain relief, complications, and the mean of the IOP at each follow-up. In the animal experiment, 18 New Zealand rabbits were divided into two groups and treated by UCP and cyclocryotherapy, respectively. The changes in the tissues and in the expression of matrix metalloproteinase-1 (MMP-1) were observed immediately. Results. The mean IOP baseline for the UCP and cyclocryotherapy groups was 54.6 ± 9.7 mmHg and 53.3 ± 11.7 mmHg, respectively. After six months of follow-up, the IOP value decreased to 30.3 ± 9.4 mmHg for the patients treated by UCP and to 30.4 ± 9.1 mmHg for those treated by cyclocryotherapy. The two groups achieved a satisfying success rate in the treatment of neovascular glaucoma of up to 70% at least. Vision impairment was observed in some patients treated with cyclocryotherapy, and these patients suffered from more complications and less pain relief than the patients who were treated with UCP. The histological study showed that the ciliary body was completely destroyed after cyclocryotherapy and that MMP-1 was found only in the ciliary muscle. After the UCP treatment, MMP-1 could still be found in the ciliary body, and only the double-layer epithelial cells presented with coagulative necrosis. Conclusion. The UCP treatment and cyclocryotherapy both showed good efficacy in significantly reducing the IOP. However, the UCP treatment was safer with less postoperative complications and adverse effects. Thus, the overall treatment effect of the UCP was more efficient than that of cyclocryotherapy.

scholarly journals Near total laryngectomy: a single institutional experience

2021 ◽  
Author(s):  
Manas P. Das ◽  
Mridul K. Sarma ◽  
Mrinmoy M. Choudhury ◽  
Ajit K. Missong
Keyword(s):  
Functional Outcomes ◽  
Total Laryngectomy ◽  
Histopathological Examination ◽  
Event Free Survival ◽  
Free Survival ◽  
Institutional Experience ◽  
The Common ◽  
Disease Free ◽  
Free Status

Background: Near total laryngectomy (NTL) aims to remove cancer of larynx and hypopharynx while maintaining a lung powered, prosthesis free voice. The oncological and functional outcomes of NTL have been encouraging but the surgical procedure is complex. In this study, we present our experience with NTL in order to encourage more ENT and head and neck surgeons to take up the procedure.Methods: Twenty-eight patients, who had undergone NTL at State cancer institute, Guwahati are analysed retrospectively for survival, disease free status, functional outcomes and complications.Results: There were two recurrences: one local recurrence which was salvaged by a completion total laryngectomy. The other patient had distant metastasis and died eventually. Overall survival (OS) was 96.43% and event free survival (EFS) was 92.86%. The patient who died had extra-nodal extension (ENE) on post op histology (p=0.274). Two patients failed to develop any speech had stenosis of the shunt. One of these was the only Salvage NTL case (p=0.057). Tracheostome stenosis, poor swallow and shunt stenosis were the common complications in our series. Most of them resolved with some intervention. Multiple complications were seen in the salvage NTL cases.Conclusions: Careful case selection and well executed surgery leads to acceptable results following NTL. Special attention should be paid to the salvage cases as they are prone to develop complications and failure to attain speech. Patients with adverse post-op histopathological examination (HPE), like ENE should be kept under close follow up.

Micropulse Transscleral Cyclophotocoagulation in the Combine Treatment of Neovascular Glaucoma

GlaucomaNews ◽  
2020 ◽  
pp. 71-75
Author(s):  
N.S. Khodzhaev ◽  
◽  
A.V. Sidorova ◽  
M.A. Eliseeva ◽  
◽  
...  
Keyword(s):  
Laser System ◽  
Combined Treatment ◽  
Neovascular Glaucoma ◽  
Ultrasound Biomicroscopy ◽  
Vascular Growth ◽  
Vegf Inhibitor ◽  
Anti Vegf ◽  
Surgical Methods ◽  
Treatment Procedures

Introduction. Neovascular glaucoma (NVG) is one of the most prognostically unfavorable forms of the glaucomatous process. The leading pathogenetic mechanism for the development of NVH is hypoxia of the inner layers of the retina, leading to the development of endothelial vascular growth factors (VEGF), which induce neovascular proliferation. In the presence of newly formed vessels in the corner of the anterior chamber, the use of traditional surgical methods for treating glaucoma is limited. That is why the search for a new pathogenetically oriented methods for the treatment of NVH is still acute issue in ophthalmology. Purpose. To evaluate the preliminary results of combined treatment, including intraocular introduction of anti-VEGF therapies (ranibizumab) and micropulse cyclophotocoagulation, in patients with secondary neovascular glaucoma. Materials and methods. The study included 15 patients (15 eyes) with secondary neovascular glaucoma. The value of intraocular pressure (IOP) before surgery ranged from 28 to 44 mm Hg. (average 36.3 ± 4.4 mm Hg), the number of hypotensive drops was 3.5 ± 0.5. The combine treat of patients including the intraocular administration of a VEGF inhibitor (ranibizumab) and through 7-14 days transscleral diode-laser cyclophotocoagulation in micropulse mode on the device «Cyclo G6 Glaucoma Laser System» (IRIDEX, USA) with a laser power of 2000 mW, an exposition of 160 s (80 s in each hemisphere) and a duty cycle of 31.3%. Results. All treatment procedures were performed without complications. By 6 months of follow-up, the average IOP level was 26.9 ± 3.3 mm Hg, the number of hypotensive drops was reduced to 2.7 ± 0.7 drugs. By 1 month of observation, a decrease in the number of newly formed vessels of the iris was achived in all patients. According to ultrasound biomicroscopy, the thickness of the ciliary body (CT) before treatment was on average 0.58 ± 0.14 mm. By 6 months of follow-up, no cases of postoperative atrophy of CT was diagnosed, the thickness of the CT was on average 0.53 ± 0.11 mm. According to the data of optical coherence tomography in the angiography mode, in all cases there was a positive dynamic in 1 month after combined treatment - a significant decrease in macular edema, the area of the retinal nonperfusion zone and the number of newly formed vessels. Conclusion. Combined treatment of patients with secondary neovascular glaucoma, including intraocular introduction of anti-VEGF therapies and micropulse cyclophotocoagulation, is an effective and safe method for reducing IOP.

scholarly journals The Effectiveness of Ultrasound Biomicroscopic and Anterior Segment Optical Coherence Tomography in the Assessment of Anterior Segment Tumors: Long-Term Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Ewa Wasiluk ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ciliary Body ◽  
Anterior Segment ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Iris Tumor ◽  
Long Term Follow Up ◽  
Additional Value ◽  
Clinic Medical

Background. Differential diagnosis and follow-up of small anterior segment tumors constitute a particular challenge because they determine further treatment procedures. The aim of this study was to evaluate the efficacy of the UBM (ultrasound biomicroscopy) and AS-OCT (anterior segment optical coherent tomography) in distinguishing different types of anterior segment lesions. Methods. It was a retrospective, noncomparative study of case series of 89 patients with the suspicion of anterior segment tumor referred to the Ophthalmology Clinic, Medical University of Białystok, Poland, between 2016 and 2020. UBM was used to assess tumor morphology including height, location, and internal and external features. In cases in which UBM did not provide enough data, the AS-OCT images were analyzed. The data on demographics, best corrected visual acuity (BCVA), intraocular pressure (IOP), and rate of complications were also collected. Patients were followed up from 1 to 48 months. Results. The mean observation period was 26.61 ± 16.13 months. Among the patients, there were 62 women and 27 men at a mean age of 55.59 ± 19.48 (range: from 20 to 89 years.) The types of tumors were cysts (41%), solid iris tumors (37.1%), ciliary body tumors (7.9%), peripheral anterior synechiae (PAS 3.4%), corneal tumors (4.5%), and others (5.6%). Patients with cysts were younger than patients with solid iris tumor (p=0.002). Women had a cyst as well as solid iris tumor more frequently than men, but less often a ciliary body tumor (p<0.05). The horizontal size of tumor was positively correlated with patients’ age (rs = 0.38 and p=0.003) and negatively correlated with visual acuity (rs = −0.42 and p=0.014). During the 4 years of diagnosis, only 2.2% of lesions exhibited growth (growth rate of 0.02 mm per year). Among 15 cases in which visualization with UBM was not satisfactory (mostly iris nevi), AS-OCT was helpful in diagnosis of 13 patients. Conclusions. Both UBM and AS-OCT are effective methods in detection and diagnosis of tumors of the anterior eye segment, but in some cases, AS-OCT adds additional value to the diagnosis. Many lesions can be managed conservatively because they did not demonstrate growth during 4 years of the follow-up period.

Gamma knife radiosurgery for uveal melanomas: an 8-year experience

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 184-188 ◽  
Author(s):  
Gerald Langmann ◽  
Gerhard Pendl ◽  
Georg Papaefthymiou ◽  
Helmuth Guss ◽  
Keyword(s):  
Gamma Knife ◽  
Ciliary Body ◽  
Tumor Regression ◽  
Gamma Knife Radiosurgery ◽  
Neovascular Glaucoma ◽  
Content Type ◽  
Prescription Dose ◽  
The Mean ◽  
Fine Print ◽  
Uveal Melanomas

Object. The authors report their experience using gamma knife radiosurgery (GKS) to treat uveal melanomas. Methods. Between 1992 and 1998, 60 patients were treated with GKS at a prescription dose between 45 Gy and 80 Gy. The mean diameter of the tumor base was 12.2 mm (range 3–22 mm). The mean height of the tumor prominence was 6.7 mm (range 3–12 mm). The eye was immobilized. The follow-up period ranged from 16 to 94 months. Tumor regression was achieved in 56 (93%) of 60 patients. There were four recurrences followed by enucleation. The severe side effect of neovascular glaucoma developed in 21 (35%) patients in a high-dose group with larger tumors and in proximity to the ciliary body. A reduction in the prescription dose to 40 Gy or less and excluding treatment to tumors near the ciliary body decreased the rate of glaucoma without affecting the rate of tumor control. Conclusions. Gamma knife radiosurgery at a prescription dose of 45 Gy or more can achieve tumor regression in 85% of the uveal melanomas treated. Neovascular glaucoma can develop in patients when using this dose in tumors near the ciliary body. It is advised that such tumors be avoided and that the prescription dose be reduced to 40 Gy.

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